This disclosure relates to laparoscopic anastomosis tools and techniques and, more particularly, to anastomosis tools and techniques that facilitate suturing.
An example of a prior art laparoscopic anastomosis technique 50 is described in U.S. Pat. No. 5,330,486—and is explained with reference to FIG. 1. In the shown technique, two organ segments 52, 54 are placed side-by-side and joined together. This joining may result in many benefits. For example, if a portion of the intestine is removed due to cancer, remaining portions of the intestine may be joined together using an anastomosis. In the example shown in FIG. 1, ends 56, 58 of the respective organ segments 52, 54, may be closed off. Connecting organ segment 52 with organ segment 54 may allow contents of organ segment 52 to flow through an opening 60 and into organ segment 54.
In order to perform the anastomosis technique, laparoscopic stapling members 62, 64 of respective laparoscopic stapling devices 66, 68, are inserted into organ segments 52, 54 via respective incisions or enterotomies 70, 72 formed in side walls of organ segments 52, 54. Laparoscopic stapling members 62, 64 are fixed to the ends of shafts 74, 76. The ends of shafts 74, 76 are adjustable by manipulating actuators 78, 80. Ends of shafts 74, 76 are inserted into a patient via respective trocar sleeves 82, 84 which traverse an abdominal wall 86.
Actuator 80 contains anastomosis staples and actuator 78 may contain an anvil member for assisting in the bending of the staple legs. A spindle 88 may be used to eject a threaded connector from actuator 80 into the anvil member. Actuator hand grips 90 are then squeezed to eject staples. Upon completion of the stapling operation, actuators 78, 80 are withdrawn from organ segments 52, 54 via enterotomies 70, 72. Enterotomies 70, 72 are then, in turn, closed.
Such prior art techniques have many problems. For example, by inserting stapling members 78, 80 through incisions 70, 72, additional suturing of incisions 70, 72 is necessitated. Moreover, these prior art techniques are limited to anastomosis using staples. However, stapling is not always the most desirable approach.
Performing an anastomosis using suturing instead of staples has advantages in many situations. At present, the majority of anastamoses are constructed outside the abdomen in laparoscopic surgery, because it is difficult for most surgeons to make the anastomosis intracorporeally. Laparoscopic assisted intestinal surgery involves mobilizing the intestine inside the abdomen, but an incision is made to extract the intestine from inside the abdomen and the anastomosis is completed through the extraction site. However, there is data to show that when an anastomosis is made intracorporeally, patients leave the hospital earlier, have less narcotic usage, have smaller extraction incisions, and have less complications when compared to extracorporeal laparoscopic assisted surgery.